Feasibility of Endoscopic Treatment of Middle Ear Myoclonus: A Cadaveric Study

Abstract

Stapedius and tensor tympani tenotomy is a relatively simple surgical procedure commonly performed to control pulsatile tinnitus due to middle ear myoclonus and for several other indications. We designed a cadaveric study to assess the feasibility of an entirely endoscopic approach to stapedius and tensor tympani tenotomy. We performed this endoscopic ear surgery in 10 cadaveric temporal bones and summarized our experience. Endoscopic stapedius and tensor tympani section is a new, minimally invasive treatment option for middle ear myoclonus that should be considered as the first line surgical approach in patients who fail medical therapy. The use of an endoscopic approach allows for easier access and vastly superior visualization of the relevant anatomy, which in turn allows the surgeon to minimize tissue dissection. The entire operation, including raising the tympanomeatal flap and tendon section, can be safely completed under visualization with a rigid endoscope.

Pain After Ear Surgery: A Prospective Evaluation of Endoscopic and Microscopic Approaches

“…To achieve sufficient view of the operating field, the microscope needs a more traumatic approach. The endoscope hypothetically will achieve the same—or better—surgical view with less trauma needed 3 . It would seem reasonable to assume that the aforementioned benefits would apply to endoscopic ear surgery.…”

A Novel Technique for the Diagnosis and Management of Middle Ear Myoclonus

“…[1][2][3][4][5][6] While the traditional trans-canal approach utilizes an operating microscope, Pollak et al described the feasibility of an endoscopic approach for improved visualization of both the stapedial and tensor tympani tendons. 7 The use of botulinum toxin has been theorized as both a diagnostic and therapeutic tool in the management of middle ear myoclonus as it provides a temporary "sectioning" of the middle ear musculature. However, there was concern for a risk of ototoxicity with intratympanic application.…”

“…Some surgeons advocate for a non‐selective sectioning of both middle ear tendons while others have attempted more selective sectioning based on clinical signs and symptoms 1–6 . While the traditional trans‐canal approach utilizes an operating microscope, Pollak et al described the feasibility of an endoscopic approach for improved visualization of both the stapedial and tensor tympani tendons 7 …”

Endoscopic and minimally‐invasive ear surgery: A path to better outcomes

“…The tensor tympani can be cut under endoscopic vision, without the need for any excessive dissection for exposure. 4 , 5 Understanding the anatomy of the middle ear recesses becomes much easier now that these recesses are visible. Endoscopes have been great for resident education in ear surgery.…”